AIDS: Closer to a Cure

Recent breakthrough research brings new hope for more effective treatment

News | Natalie Lampert, Hannah Stadlober | September 2010

It was a windy evening in July, Vienna’s summer sky was precariously dark, and there was a fly floating in the wine. We were having dinner at the Naschmarkt with Dr. Lokesh Agrawal and Dr. Olivier Ducoudret, two of the 25,000 doctors in Vienna in July for the 18th International AIDS Conference. They were from RAPID Laboratories, Inc., a peptide-based research facility located in Maryland, U.S. and headquartered in Switzerland.  The doctors are among the leading researchers in the field, and this was our last interview. And that damn insect swimming in the Grüner Veltliner was making us both nervous.

Between July 16 and 23, the Life Ball and the 2010 AIDS Conference, along with its highly selective pre-conference workshop, made Vienna the center of HIV/AIDS awareness and the occasion for an unusual call for the sharing of research in the hopes of breaking through the barrier to more effective treatment. Eyeing the now drowned creature with distaste, we wrenched our attention back to Dr. Agrawal, who was in the midst of explaining why the 2010 AIDS pre-conference workshop was so important.

"It is aimed at bringing together scientific experts to encourage collaboration," he was saying, "in order to eliminate the reservoirs in which the final bits of the virus remain. This would be a huge development..."

Mid-sentence, Dr. Agrawal noticed the fly in the wine glass, and immediately raised his hand for the waiter. "A new glass," he requested. Problem solved; in seconds. Soft-spoken, but very direct. It seemed like a metaphor; this was someone who did not want to distract himself with irrelevancies.

"Every five seconds someone is infected with HIV," he said, forks paused in mid-air. We stared. Most of us had no idea.

"It’s high-time for a cure," Dr. Ducoudret added, his pleasing French accent unable to soften the severity of his statement. "Really, it’s now or never."

Worldwide, the suffering is staggering. Since its discovery in 1981, HIV has claimed 25 million deaths.

Despite cosiderable progress in the field of HIV/AIDS research, more people are becoming infected with the deadly virus than are receiving sufficient treatment. Although HIV patients can lead a relatively normal life with the right care, potent drug regiments are still needed to turn the once deadly disease into not only a manageable chronic illness, but a curable one.

In order to reach this ambitious goal, "meetings like the AIDS conference and the workshop are essential for us," Agrawal told us. "Since each paper presented is worth at least five years of hard work, we can gather a lot of useful information and increase our knowledge base."

First held in Atlanta in 1985, the conference is organized by the Geneva-based International AIDS Society (IAS), that with more than 13,000 members is the leading organization for HIV/AIDS researchers worldwide. Held every two years and attended by scientists, activists, patients and even economists, the AIDS Conference is the largest and most important one of its kind, providing a platform for the exchange of information on the latest developments relating to HIV/AIDS research.

Vienna has a long commitment to the struggle against HIV and AIDS. Hosting the Life Ball – the biggest AIDS charity event worldwide – since 1993, the city has been setting a strong example.

"This year’s ball is the biggest since its creation 17 years ago," said Christine Marek, State Secretary of the Austrian Federal Ministry of Economy, Family and Youth, in her opening speech at the official reception organized by the IAS and the Austrian Federal Ministry of Science and Research. The reception, held on Jul. 16, was attended by the leading researchers participating in the pre-conference workshop, "Towards a Cure: HIV Reservoirs and Strategies to Control Them."

One after another, the speeches were characterized by a constant call to the young generation of researchers to take on the challenge of finding a cure.  "The younger generation must now deliver," said IAS President Julio Montaner. Francoise Barre-Sinoussi, recipient of the 2008 Nobel Prize for Medicine, reinforced the message, reiterating "the need to define new strategies" in order to stimulate a new generation to work together in an effort to find a cure.  Thus, it seemed only appropriate that the "IAS/ANRS Young Investigator Prize on HIV Reservoirs" was awarded to a young scientist in the course of the reception.

"I, myself, received such an award in 2002 for my work on CCR5 deletion," Agrawal whispered to us as the young French-Canadian winner Patricia Monteiro and the renowned Nobel Prize Laureate smiled together into the camera. The young man’s voice glowed with pride as he explained what exactly had earned him the award, while the four of us stood and talked quietly around a white-clothed table, enjoying the "flying buffet" of succulent hors d’oeuvres served en passant by liveried wait staff.

Over portions of "mini Wiener Schnitzel" – presented in quite an unconventional ball-like shape – and petite, mouth-watering apricot tarts, Drs. Agrawal and Ducoudret introduced us to the current status of HIV/AIDS research and the most prevalent forms of treatments. After one hour of feverish note taking, an immense amount of medical terminology, and Agrawal’s dry remark that "this is only the starting point for our research," we realized we needed a lot more time and agreed to meet again the next day for another lengthy interview. Gradually, the pieces were beginning to make sense.

The Human immunodeficiency virus (HIV) is a so-called retrovirus that uses the enzyme reverse transcriptase to make copies of its own genetic make-up while integrating its material into that of the host, thus disrupting the immune cells and making the body vulnerable to diseases. Therefore, treatments to prevent these opportunistic infections are needed in addition to anti-retroviral drugs that serve to bring the destruction of the immune system to a halt. In recent years, HAART (short for highly active antiretroviral therapy) has become the most common antiretroviral drug regiment. But "although it works as best as it can, it does not do the job 100%," Dr. Agrawal explained.

"The life expectancy of patients taking HAART, for example, still does not match that of healthy people," Dr. Ducoudret added and contemplated, "the problem is that patients do not want to take HAART forever. They want to take a drug and get better." HAART, however, has numerous side effects and does not kill the virus - "which would be the ultimate goal."

So, what was all the excitement about the 2010 AIDS pre-conference workshop? For one thing, its goal to encourage collaboration on the so-called reservoirs. Using HAART and eliminating the reservoirs in which the final bits of the virus remain would not be the end of the story, according to the two doctors. "But it would be a huge development."

"The research community, however, does not agree on where in the body these reservoirs are located," Ducoudret explained to us.

Another factor was its selectivity – only 65 doctors were chosen to present and discuss their abstracts. Drs. Agrawal and Ducoudret were selected because of their unique hypothesis that monocytes – a type of white blood cell found in the body’s immune system – are one of the main reservoirs where latent bits of the virus may be hiding.

RAPID Pharmaceuticals, founded in 2007, is a for-profit, private company headquartered in Switzerland that draws on more than 20 years of previous peptide research work. In 2008, the company formed RAPID Laboratories Inc. in Maryland (U.S.) to research and develop peptide-based disease therapies. It is here that Drs. Agrawal and Ducoudret have been researching monocyte reservoirs. "Monocytes have been missed as the true reservoir," Ducoudret says. "Instead, most attention has been paid to T-cells."

Do they believe a cure will be found in the future? Agrawal, who characterized himself as an optimist, is sure that scientists will discover a "wonder drug in the near future," allowing them to cure HIV-infected patients. "And they’ll make a lot of money by doing so," he added, a big grin on his face. It was hard not to believe in this charismatic scientist, who said that, ten years after HAART was first introduced, "it is now time to finish the job."

"What makes you so sure about that?" Ducoudret countered in a quiet but compelling voice. He is French – and far more skeptical. "It’s dangerous for scientists to offer timelines and promises," he cautioned. "Though it will be a huge development, eliminating the virus is not the end of the story. The virus is too smart and too adaptable, and so it will always come back." He doubted that a cure, or a vaccine, would be discovered in the next ten years but was convinced, however, that people on HAART therapy would be able to "live a normal life" with increased life expectancy.

"I do believe," Ducoudret said, "that at some point in the future, there will be a cure – but HIV patients will keep a trace of the virus all their lives."

To reach these ambitious goals, both doctors emphasized, money is needed, and lots of it – to conduct more research, to raise awareness among the groups most affected by the virus, and to develop a vaccine to prevent future infections. Thus, combating what is arguably the most political disease in the world will likely continue for years to come.

Still, the developments are exciting. If the last week of July in Vienna was any indication, a new spirit of optimism has taken hold in the field. And recent break-through research – such as RAPID Laboratories’ work targeting monocytes as potential hosts of the virus – may mean that a true cure for HIV/AIDS is no longer beyond the realm of imagination.

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    the vienna review September 2010